Intraocular pressure elevation after Descemet’s stripping endothelial keratoplasty

Ozeki, Naoki; Yuki, Kenya; Shiba, Daisuke; Shimmura, Shigeto; Doğru, Murat; Tsubota, Kazuo

doi:10.1007/s10384-012-0149-0

Cited by 20 publications

(9 citation statements)

References 22 publications

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“…Our results agreed with Ozeki et al 24 finding that combined surgery was not associated with OHT after DSAEK, although there was a significant difference between pseudophakic and phakic eyes in IOP elevation after DSAEK (p=0.024). On the other hand, another significant risk factor in this study was preoperative IOP>16mmHg (p=0.003), which had 5.27 times risk of developing OHT after DSAEK.…”

Section: Discussionsupporting

confidence: 92%

Incidence and Risk Factors of Ocular Hypertension/Glaucoma After Descemet Stripping Automated Endothelial Keratoplasty

El‐Alfy¹,

Maqsood²,

Soliman³

et al. 2021

OPTH

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To evaluate the incidence, demographics, associated risk factors, management and clinical outcomes of ocular hypertension/glaucoma after Descemet stripping automated endothelial keratoplasty (DSAEK). Methods: A cohort review of 81 DSAEK cases was performed at Queen Victoria Hospital, United Kingdom. Patients with pre-existing glaucoma, transient increased IOP within the first 48 hours post-graft, additional post-transplant surgery, or failed to complete one year follow-up were excluded from the study. Ocular hypertension was defined as intraocular pressure (IOP) elevation >21mmHg or ≥6mmHg from baseline at any postoperative visit. The study looked at the incidence, risk factors, response to anti-glaucoma treatment, graft failure and best corrected visual acuity. Results: The incidence of post-DSAEK ocular hypertension and glaucoma was 51.9% and 13.6%, respectively. Steroid-induced IOP elevation was the most frequent cause, with an incidence of 38.3%. Risk factors such as pseudophakia (p=0.024) and preoperative IOP>16 (p=0.003) were found to be associated with post-DSAEK ocular hypertension. Preoperative IOP>16 had 5.27 times risk of IOP elevation. Eyes with graft dislocation and/or detachment were significantly associated with post-DSAEK glaucoma (p=0.038). There was no negative effect of OHT on visual acuity and graft status. Conclusion: Glaucoma and OHT are common postoperative complications of DSAEK. Although steroid-induced IOP elevation was the most frequent cause, there are other reasons associated with development of post-DSAEK glaucoma, including graft dislocation and detachment. Eyes with preoperative IOP>16 mm Hg may require a close monitoring of IOP. In addition, management by medical treatment results in good visual acuity and graft clarity.

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Section: Discussionsupporting

confidence: 92%

Incidence and Risk Factors of Ocular Hypertension/Glaucoma After Descemet Stripping Automated Endothelial Keratoplasty

El‐Alfy¹,

Maqsood²,

Soliman³

et al. 2021

OPTH

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“…Thought to be related to decreased aqueous outflow facility at the trabecular meshwork (TM), [ 1 – 16 ] steroid-induced open-angle glaucoma (SIOAG) occurs more often in those who are genetically susceptible [ 5 – 7 , 17 – 20 ] or have clinical risk factors. [ 5 , 6 , 16 ] Reported routes of corticosteroid administration that may induce steroid response include topical eyedrops, [ 21 , 22 ] topical cutaneous ointments, periocular injection, intraocular injection, [ 23 – 27 ] inhalational spray, [ 5 , 28 , 29 ] intranasal spray, [ 30 ] and oral/systemic. [ 5 , 23 , 29 , 31 – 35 ] Standard treatment options include: trabeculectomy, aqueous shunt implantation, and cyclodestructive procedures.…”

Section: Introductionmentioning

confidence: 99%

Outcome of primary trabeculotomy ab interno (Trabectome) surgery in patients with steroid-induced glaucoma

et al. 2016

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To determine the efficacy and safety of Trabectome surgery on patients with steroid response, ranging from ocular hypertension refractory to maximal medical therapy to the development of steroid-induced glaucoma.A nonrandomized, nonblinded, retrospective study of 20 subjects with steroid response was conducted. All 20 eyes underwent Trabectome surgery alone. Nine subjects had steroid response with unremarkable visual field, 3 had mild steroid-induced glaucoma, and 8 had advanced steroid-induced glaucoma. Outcome measures included intraocular pressure (IOP), number of glaucoma medications, need for secondary glaucoma surgery, and steroid regimen. Mann–Whitney U test was used to compare postoperative IOP and number of medications to preoperative IOP and number of medications. Kaplan–Meier was used for survival analysis, and success was defined as: IOP reduced by 20% or more on any 2 consecutive visits after 3 months; IOP ≤21 mm Hg on any 2 consecutive visits after 3 months; and no secondary glaucoma surgery.The average preoperative IOP was 33.8 ± 6.9 mm Hg and average preoperative glaucoma medication usage was 3.85 ± 0.75 medications. At 12 months, the IOP was reduced to 15.00 ± 3.46 mm Hg (P = 0.03) and glaucoma medication was reduced to 2.3 ± 1.4 (P < 0.01). The survival rate at 12 months was 93%. At 12 months, 10 patients were continued on their preoperative steroid treatments, 5 were on tapered steroid treatments, and 5 had ceased steroid treatments entirely. One patient required secondary glaucoma surgery (glaucoma drainage device). No other complications were noted.The Trabectome procedure is safe and highly effective for steroid-response glaucoma, even in the context of continued steroid treatment.

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“…Twelve-month incidence of post-surgical IOP elevation ranges from 6 to 16% and of post-DMEK glaucoma from 2 to 4% in patients after DMEK surgery [19,[21][22][23][24][25][26][27]. In patients with pre-existing glaucoma, the risk for both is significantly increased as previously shown: In this study, steroid-induced IOP elevation was a common cause for postoperative IOP elevation, but proportionally less often than in other DMEK patients [19,22,28].…”

Section: Iop Elevation and Post-dmek Glaucomamentioning

confidence: 59%

Graft failure rate and complications after Descemet membrane endothelial keratoplasty in eyes with pre-existing glaucoma

Maier

Pilger

Gundlach

et al. 2022

Graefes Arch Clin Exp Ophthalmol

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Purpose To evaluate the outcome of Descemet Membrane Endothelial Keratoplasty (DMEK) in eyes with pre-existing glaucoma. Design In this retrospective, observational case series we included data of 150 consecutive DMEKs in eyes with pre-existing glaucoma of 150 patients after excluding data of the second treated eye of each patient and of re-DMEKs during follow-up. Cumulative incidences of IOP elevation (IOP > 21 mmHg or ≥ 10 mmHg increase in IOP from preoperative value), post-DMEK glaucoma (need of an additional intervention due to worsening of the IOP), graft rejection, and graft failure rate were analyzed using Kaplan–Meier survival analysis. COX regression analysis was used to evaluate independent risk factors. Results The 36-month cumulative incidence of IOP elevation was 53.5% [95 CI 43.5–63.5%] and of post-DMEK glaucoma 36.3% [95 CI 26.3–46.3%]. Graft rejection occurred with a 36-month cumulative incidence of 9.2% [CI 95% 2.3–16.1]. None of the analyzed risk factors increased the risk for the development of graft rejection. The 36-month cumulative incidence of graft failure was 16.6% [CI 95% 8.4–24.8]. Independent risk factors for graft failure were the indication for DMEK “status after graft failure” (n = 16) compared to Fuchs’ dystrophy (n = 74) (p = 0.045, HR 8.511 [CI 95% 1.054–68.756]) and pre-existing filtrating surgery via glaucoma drainage device (GDD) (n = 10) compared to no surgery/iridectomy (n = 109) (p = 0.014, HR 6.273 [CI 95% 1.456–27.031]). Conclusion The risks of postoperative complications (IOP elevation, post-DMEK glaucoma, graft rejection, and graft failure) in patients with pre-existing glaucoma are high. In particular, pre-existing filtrating surgery via GDD implantation—but not trabeculectomy—and DMEK after graft failure increase the risk of graft failure.

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Intraocular pressure elevation after Descemet’s stripping endothelial keratoplasty

Abstract: IOP elevation appears to be a common postoperative complication of DSEK. Patients without preexisting glaucoma but with higher pre-op IOP need to be followed up carefully after DSEK.

Cited by 20 publications

References 22 publications

Incidence and Risk Factors of Ocular Hypertension/Glaucoma After Descemet Stripping Automated Endothelial Keratoplasty

Incidence and Risk Factors of Ocular Hypertension/Glaucoma After Descemet Stripping Automated Endothelial Keratoplasty

Outcome of primary trabeculotomy ab interno (Trabectome) surgery in patients with steroid-induced glaucoma

Graft failure rate and complications after Descemet membrane endothelial keratoplasty in eyes with pre-existing glaucoma

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